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Original Investigation |

Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths

Lucas Godoy Garraza, MA1; Christine Walrath, PhD1; David B. Goldston, PhD2; Hailey Reid, MPH1; Richard McKeon, PhD3
[+] Author Affiliations
1Public Health Division, ICF International, New York, New York
2Duke University School of Medicine, Durham, North Carolina
3Substance Abuse and Mental Health Services Administration, Rockville, Maryland
JAMA Psychiatry. 2015;72(11):1143-1149. doi:10.1001/jamapsychiatry.2015.1933.
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Importance  Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse.

Objective  To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously.

Design, Setting, and Participants  We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score–based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant.

Exposures  Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines.

Main Outcomes and Measures  Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011.

Results  Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates.

Conclusions and Relevance  Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.

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Figure 1.
Sample Selection Procedures

NSDUH indicates National Survey on Drug Use and Health.

aIntervention counties were identified based on implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (referred to as the GLS program); control counties were selected post hoc.

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Figure 2.
Main (A) and “Control” (B) Outcomes Following Implementation of the GLS Program

Estimated trajectories of the attempt rates over a 3-year period for counties following 2 hypothetical patterns of implementation: counties implementing Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program) activities for 1 year but not the subsequent 2 years (solid line) and counties not implementing GLS program activities in any of the 3 years (dashed line). The trajectories are estimated with a linear regression that combines information from the different patterns of implementation actually occurring during the period from 2006 to 2009. The 90% and 50% CIs around the difference in the trajectories are represented by the dark and light gray shading, respectively.

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